Provider Demographics
NPI:1770348153
Name:WALTHALL COUNTY BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:WALTHALL COUNTY BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-303-0472
Mailing Address - Street 1:125 OLD STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-5020
Mailing Address - Country:US
Mailing Address - Phone:601-303-0472
Mailing Address - Fax:
Practice Address - Street 1:125 OLD STATE LINE RD
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-5020
Practice Address - Country:US
Practice Address - Phone:601-303-0472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty